Acute flaccid paralysis due to multifactorial hyperkalaemia

Area of Science:

• Nephrology
• Oncology
• Neurology

Background:

• A male patient with Lynch syndrome and relapsed colorectal cancer presented with acute neurological decline.
• He had recently commenced chemotherapy, a potential factor in his presentation.

Observation:

• The patient experienced progressive flaccid paresis affecting all limbs with areflexia.
• Investigations revealed severe hyperkalaemia, acute kidney injury, hyperuricaemia, and bilateral hydronephrosis secondary to pelvic mass obstruction.

Findings:

• Treatment focused on correcting hyperkalaemia and addressing presumed tumor lysis syndrome with rasburicase.
• The patient demonstrated a rapid and favorable clinical response, with complete motor recovery within hours and progressive renal function improvement.

Implications:

• This case underscores the critical importance of recognizing and promptly managing severe hyperkalaemia.
• It highlights that hyperkalaemia, a potentially fatal condition, can manifest as acute flaccid paralysis and may be linked to various underlying causes, including malignancy and its treatment.